Project Summary/Abstract Despite the high incidence of mild traumatic brain injury (mTBI) or concussion in youth, there are no standardized evidence-based treatments available and there is a dearth of trials examining early treatment approaches. Consequently, there is a critical need to develop highly usable management strategies to support recovery. To address this need, we propose to develop and assess an innovative, gamified mobile learning environment (GMLE) for youth with mTBI to promote real-time symptom self-management and self-efficacy that is not possible with traditional, intermittent medical follow-up. Youth are the ideal targets for an eMedicine approach due to their risk of persistent symptoms, aptitude for technology, and advancing independence with increasing personal efficacy. Despite successful application of self-management principles to several chronic conditions, there are no current reports of a program designed to facilitate active problem solving and self- management in youth with mTBI. As a prototype, we will use our recently developed web-based program, Self- Management Activity-regulation and Relaxation Training (SMART), which integrates real-time self-monitoring of symptoms and activities (from patient web-based entry) with modules designed to increase self-efficacy through psychoeducation and training in problem solving/problem-focused coping strategies. In the first phase, we will incorporate feedback from prior work and input from a collaborative design team to transform the original SMART prototype into a GMLE. Planned modifications include an avatar-based pedagogical agent to act as a virtual coach and digital badging to incentivize completion. Following usability testing and iterative refinements, in the second phase, we will conduct a pilot randomized controlled trial involving 100 youth with mTBI, ages 11 to 18, and their parents to assess safety and feasibility, and estimate effects on coping and psychological functioning as compared to usual care. Outcomes will be assessed at weekly intervals over a month timeframe following baseline via online links. We hypothesize that participants receiving SMART will report high usability and satisfaction with the program and no adverse effects. We further hypothesize that participants in the SMART intervention group will report higher levels of active coping, greater self-efficacy, sense of well-being, and quality of life and lower levels of distress than those receiving usual care. Exploratory analyses will examine group differences in post-concussive symptom resolution over time. Given the lack of evidence-based interventions to promote self-management and recovery following pediatric mTBI, this study targets a critical social and scientific concern. Findings from this study will inform subsequent larger scale trials that could ultimately transform management of pediatric mTBI.